Notes from the Field: The Construction of a Logistical Model for Sports-Related Injury Risk Assessment. A Cross-Sectional Pilot Study

Handball is a high-intensity contact sports activity characterized by repetitive movements, leading to sport-specific muscle patterns. However, at some stage, this pattern may turn into imbalance, predisposing athletes for injuries. The complexity of muscular interactions often makes it difficult to see a whole picture of an athlete’s postural disorders and assess them within the framework of his stereotyped movements. We attempted to find an association between the muscle pattern and the number of injuries in a limited group of handball players by constructing a static logistical model. The constructed decision table of the static logistical model included seven conditional attributes of the muscle imbalance as preconditions for injury development and one decision attribute representing the number of experienced injuries of 25 university handball players. The findings displayed a sport-specific pattern of muscle alignment in athletes without or only one injury. However, all players with repetitive injuries had unilateral m. gluteus maximus weakness. In the latter case, impaired core body musculature can lead to increased share forces and stress for the gluteus maximus muscle leading to weakness of this crucial dynamic stabilizer. The logistical model allowed defining muscle imbalance associated with sports-related injuries in a limited group of athletes.

Ischiadic Nerve Lesion Due to Metastasis of a Non-Differentiated Urethra Carcinoma: Case Report and Review of the Literature

In clinical practice, we encounter mechanical lesions of the ischiadic nerve most frequently with a trauma of the pelvis circle or because of surgical injury in the alloplastic treatment of the hip joint. Other causes for nerve lesions are sporadic or even rare. To such ones also belongs compression of the nerve by metastasis of a urethra carcinoma to the gluteus maximus muscle. A typical manifestation of this nerve injury is a tibioperoneal paresis with a preponderance in its peroneal component. The diagnostic process can be additionally complicated by a contemporal vertebrogenic syndrome with radiculopathy, the more so, when an intervertebral disc protrusion on imaging would be discovered. We present a case of a woman with a two-year history of an undifferentiated urethra carcinoma which has metastasized into the gluteus muscle and has produced a compression of the ischiadic nerve.

Hematoma After a Fluoroscopically Guided Sacroiliac Joint Injection: A Case Report

Background: Sacroiliac joint injection continues to play a role in the diagnosis and therapeutic management of patients with sacroiliac joint arthropathy, as it provides pain relief and improvement in function to those patients. It is considered a low-risk pain procedure with minimal to no adverse side effects. Although rare, serious com-plications such as infection and hematoma are a possibility, however. In anticoagulated patients, interventional pain physicians are advised to weigh the risks and benefits before discontinuing anticoagulation. The literature describes serious complications associated with stopping anticoagulation, such as myocardial infarction. Howev-er, we should also be mindful of the possibility of intramuscular hematoma formation in anticoagulated patients receiving a fluoroscopically guided sacroiliac joint injection. Case Report: This case exposes the development of a 300-mL hematoma in the right gluteus maximus muscle after a fluoro-scopically guided sacroiliac joint injection in a patient who was taking warfarin. Consequently, she also developed neurologic symptoms such as new-onset urinary retention, weakness, and decreased sensation in her right leg. Conclusion: Pain physicians should be mindful of the risks and benefits before deciding to hold or discontinue anticoagulation in patients undergoing fluoroscopically guided sacroiliac joint injection, as intramuscular hematomas are a possible complication. Key words: Anticoagulation, hematoma, sacroiliac joint arthropathy, sacroiliac joint injection complications

Normalized apparent diffusion coefficient: a novel paradigm for characterization of endometrial and subendometrial lesions

Objectives: To assess the role of normalized apparent diffusion coefficient (ADC) in characterization of endometrial and subendometrial masses, measured as a ratio of the mean ADC of the pathology to mean ADC of two different internal controls, normal myometrium and gluteus maximus muscle, referred to as nADCm and nADCg respectively. Methods: 55 females with pathologically proven endometrial and subendometrial lesions, including 27 cases of endometrial carcinoma, and 28 cases of benign masses were enrolled in this prospective study and assessed with single-shot echoplanar diffusion-weighted imaging. The normalized and absolute ADC of the lesions, measured by two radiologists, were compared in different pathologies and receiver operating characteristics (ROC) performed to distinguish benign and malignant endometrial masses. In the endometrial carcinoma group, the ADC values were further compared with tumor grade and subtype. Results: There was good interobserver agreement (>0.800) for both internal controls, however it was higher for myometrium [intraclass correlation coefficient-0.92; confidence interval (0.86–0.95)] than gluteus maximus muscle [ICC-0.84; CI (0.72–0.90)]. There were statistically significant differences in absolute ADC (p-0.02), nADCm (p-0.02) and nADCg (p < 0.0001) of benign and malignant endometrial masses. Conclusion: Normalized ADC is useful to distinguish benign and malignant masses with comparable accuracy as absolute ADC. Advances in knowledge: Normalized ADC represents an easily measurable quantitative parameter which limits the influence of endogenous and exogenous factors that affect its reproducibility.

Hatchet Thigh Flap with Hemi-gluteus Flap for Recurrent Ischial Sore Reconstruction

Background: Ischial pressure sores are the most challenging sores to treat because of associated bursa and high rate of recurrence. Reconstruction flaps originating in the thigh have a disadvantage as movement may increase shear forces, and tension during closure may lead to wound dehiscence. To circumvent these problems, we hereby present a hatchet thigh flap with good mobility, which can be used for recurrent cases as well.Methods: All patients treated at our hospital in the last 5 years for ischial pressure sores were included in the study. The flap is elevated in the subfascial plane from lateral to medial until the medial circumflex artery perforators are revealed. In recurrent cases the lower half of the gluteus maximus muscle is used to fill in the cavity while the flap from the previous surgery is re-advanced.Results: Sixteen patients (11 males and five females) were in the study. The median age of the patient was 54 years (range, 25–82 years). All the flaps survived fully. Two patients had recurrence at three sites, which were successfully reconstructed by advancing the same flap and hemi-gluteus muscle. An average of 6 months follow-up after surgery for recurrence showed stable reconstruction.Conclusion: The hatchet thigh flap is easy to dissect and reliable for ischial pressure sores. It can be used effectively in recurrent cases when combined with hemi-gluteus flaps.

Assessment of hip muscles by surface EMG in gait analysis

Objectives: The rectus femoris muscle flexes the thigh, while the gluteus maximus muscle extends it. Understanding the activations of these two muscles that function in opposition to each other during walking facilitates the interpretation of gait pathologies. The aim of this study was to evaluate the activations of these muscles during walking by using the surface electromyography (EMG) technique. Methods: Twenty female volunteers aged 18–26 years participated in our study. The electrical activation of the rectus femoris and gluteus maximus muscles of the participants was simultaneously evaluated by gait analysis. At the same time, spatiotemporal parameters and phase parameters were obtained. Results: The activation pattern of both muscles was found to be similar. Both muscles reached the highest activation in the swing phase. The lowest activation was also seen in the pre-swing phase. Both muscles were observed to be active in the loading and single-limb support phases. Conclusion: The fact that these two antagonists muscles are active at the same time suggests that one is functioning concentrically, while the other eccentrically. Thus, stabilization of hip joint is provided when the body moves forward.